Information
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Delivered date
Identification of the Employee
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Name
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Job Title
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Department
PPE Delivered
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Press add element for chose the PPE
PPE
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PPE Delivered
- Boots when caring of near of loads
- Glove Basalt for precision tasks requiring dexterity and flexibility (resist 4, blad 1, tear 3, puncture 1)
- Glove cut (resist 4, blad 5, tear 4, puncture 2)
- Glove Leather rigging, strapping and vehicle handling
- Glove Cut 5 Grip Palm Nitrile (resist 4, blad 5, tear 4, puncture 2)
- Googles EN166-B 4 (medium energy impact and liquids)
- Helmet working with overhead loads
- Hi Vis Waistcoat, Polo, Sweat working near of mobile equipment
- Long sleeve Tshirt 100% cotton near of high temperatures
- Safety Glasses EN166-F
- Termal Base Layer Tops
- Trousers
- Termal Base Layer Leggings
- Termal Hat
- Other PPE
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Description of the PPE
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Hazards
- Sharp and cutting objects, Cuts and Others
- Blows in the head
- Foot crush
- Entrapment and run over
- Cuts and burns
- Fall from height
- Falls at the same level
- Falling objects
- Fall by slippery
- Particle projection
- Electrocution
- Weather conditions
- Other
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Size/Other
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Hazards
- Sharp and cutting objects, Cuts and Others
- Blows in the head
- Foot crush
- Entrapment and run over
- Cuts and burns
- Fall from height
- Falls at the same level
- Falling objects
- Fall by slippery
- Particle projection
- Electrocution
- Weather conditions
- Other
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Size/Other
Declaration
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I declare that I received the Personal Protective equipment (PPE) above mentioned and that I have been informed on the hazards they cover. I assume the compromise to use them in a correct way according to the instructions also received, to maintain them in good conditions and to participate to my supervisor hierarchy all the defects and deficiencies that I know.
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The worker Sign:
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Authorized by:
